Bryan Caplan

Should I Get LASIK?

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Hansonian doubts aside, I've been thinking about getting LASIK (laser corrective eye surgery) for a couple of years. By making a small investment of discomfort and cash, I could save about 30 hours of time per year (cleaning glasses, doctor appointments, eye care store visits) for decades. And I could see and swim at the same time. For someone like me who strives to maximize expected utility with a zero discount rate, this sounds like a good deal.

But what about the risks? The Wikipedia article was by far the most informative source - actual numbers, with excellent documentation. The one that worried me the most was elevated risk of chronic dry eyes - about 5% for Caucasians (relative to a baseline of something like 2-3%).

My other problem is that I'm incredibly squemish. If I had an appointment for LASIK in two weeks, I'd be stressed for the full two weeks.

So, Econlog readers, once you know the facts, what would you, as my health economists, advise?


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The author at Remains of the Day in a related article titled Quickies writes:
    Economist Bryan Caplan wonders whether or not he should get LASIK. As an economist, he weighs the pros and cons. Okay, hybrid vehicles' fuel economy ratings have been downgraded to account for more typical driving conditions. I think most... [Tracked on May 15, 2007 3:18 PM]
COMMENTS (17 to date)
Dan writes:

I have been considering Lasik for about 2 years very seriously. My biggest problem is picking a surgeon to go with. Originally I was going to go with one that came highly recommended (though pricey) but they unfortunately closed up their local branch.

My company recently got a health insurance service that will call and find out whatever information you desire from a variety of doctors (whether the procedure is covered by the insurance or not). I think I will use this to compile a comparative list, including such things as error rate, cost. cost of future adjustments, etc.

If there is a good alternative way to choose a Laski doctor I would like to know.

hanmeng writes:

The reasons I haven't had it done, in order of importance:
1) the (slight) risk
2) my time isn't worth much
3) it doesn't correct presbyopia, so I'll still have to wear glasses much of the time.

FC writes:

I had LASIK surgery some years ago. It was one of the best decisions I ever made. I went from legally blind to better than 20/20 with no side effects. My investment of money and stress has been paid back many times over.

I can testify that the surgery itself is mildly disconcerting but painless, fast and not even very uncomfortable.

Barry Cotter writes:

Consider PRK with wavefront as well. For an informative if informal discussion on it, here

Tim Lundeen writes:

An eye-doctor friend of mine who does this as part of his business had it done for himself, so that is a strong recommendation. I have not had it done and have developed very dry eyes anyway; GenTeal drops every few hours work wonders.

For me, I don't mind glasses; the frames today are very light, and the coatings on the lenses are so hard that cleaning them is easy. So I don't mind the minor inconvenience vs the (slight) risk that my vision could be damaged.

Saul writes:

I wore glasses from around 3rd grade on and elected to get LASIK surgery when I finished graduate school. The procedure itself was almost painless. (The device they used to hold my eyelids open was uncomfortable, but otherwise I didn't feel a thing.) It's a little disconcerting to have someone operate on your eye while you're fully conscious, but if you can tolerate a trip to the dentist, you can tolerate this. :)

That's been 9 years ago now and I am still very happy with the results. The ability to see without glasses has been great, plus I can now wear nice sunglasses again insteady of the clunky prescription ones. Definitely worth every penny.

Dustin Haynes writes:

I had Lasik four years ago. Never had any problems. My wife and my dad had it done as well, and everything has been great. The only tradeoff, for me, has been that it made me slightly farsighted. So it's not perfect, but I don't need glasses, nor do I have trouble reading, driving at night, etc.

asg writes:

My father is an inventor of optical medical products and procedures and he knows quite a few ophthalmologists and researchers in the field. In general he is not 100% sold on LASIK. The dry eyes issue is worth considering, as is the possibility that the beneficial effects of the surgery will wear off if your vision continues to worsen. There is also the possibility of the scars dislodging in high pressure situations (so no riding the G-Force ride at the carnival!).

I decided not to get the procedure, but I recently had an eye test in which it was clear that my vision has more or less stopped getting worse, so now I am reconsidering. I'll talk to my father again over Memorial Day.

Robert Book writes:

Bryan,

As a bona fide health economist (if I do say so myself! ;-), I can tell you the following:

1) The price will be a lot lower that it would otherwise be because it's not covered by (most people's) insurance. Most writers on health care (including economists) miss this salient fact!

2) You need to consider your disutility, if any, from wearing glasses -- not just the time spent obtaining and cleaning them.

3) Consider also the long-term effects. For example, eyesight naturally declines with age. Will this continue even if you have LASIK? If so, will you at some point have to get it again (or wear glasses again)? It may be hard to get a straight answer from the doctors on this, given their agency issues. Try searching the medical literature.

Of course, not having access to your utility function, I can't tell you whether to do it or not . ;-)

And, since my glass correct a problem that LASIK can't correct, I can't say anything from personal experience.

J L writes:

As luck would have it, I just returned from the ophthalmologist today. I had LASIK about three years ago and generally have been pleased with the results. About a year ago, I noticed that I had trouble reading digital clocks in low light, and now signs and screens in dim light are difficult to decipher. Given some of the comments I had read about LASIK and dim light halos, I had been concerned that glasses would not fix the problem. Fortunately, the problem is simply that I am now slightly nearsighted (once again). I will have to wear glasses for driving at night and watching PowerPoint presentations (assuming I wouldn't rather just let the PowerPoint slides disappear into a blur), but being able to ski, swim, and play soccer without corrective lenses still makes the surgery worthwhile. I suppose there is some chance that my eyes will continue to worsen and that the benefits of the surgery will disappear, but according to the doctor (who had LASIK himself and seems pretty honest), very few patients ever need prescriptions over -1 after surgery. There is even a benefit to being slightly nearsighted--it delays the need for reading glasses.

Dan G writes:

[Comment deleted for supplying false email address. To restore this comment email the webmaster@econlib.org -- Econlib Editor]

Dr. T writes:

There are two common risks from the surgery. You mentioned the doubled risk of chronic dry eyes. The other risk is that uncorrected vision will be 20/40 or poorer. This risk is higher with poorer vision.

My uncorrected vision is a terrible 20/900 (complicated by astigmatisms). However, my vision with glasses is 20/15. I was told there was only a 50% chance for me to have 20/20 vision post-LASIK. I would still need to wear (weaker) glasses if I ended up 20/30 or 20/40 or worse. I chose to forgo LASIK.

A sidenote concerning older people –

An ophthalmologist cautioned me against LASIK surgery because the benefits of LASIK surgery are discarded with cataract surgery. I am 59 and have early signs of cataract development. In cataract surgery they throw away your natural lens and make you a custom plastic lens, with a good chance they can fix you to 20/20. So any benefits which I might gain from LASIK would end when and if I advance to cataract surgery.

But I still want to get rid of these thick eyeglasses. So I am considering getting that lens replacement surgery done now (waiting neither for cataracts to develop nor for the government payment for this procedure which is likely to come by the age of cataracts). If I have learned the lingo, this is called "clear lens extraction", which I am likely to undergo as an alternative to LASIK.

[Comment corrected at commenter's request--Econlib Editor]

Tom Crispin writes:

Will it improve your mate value, and does that matter? If yes, the cost is irrelevant. If no, the risks aren't worth it.

These same questions apply in deciding whether to get contact lenses versus normal glasses. I got contacts 30 years ago; would have done LASIK then but it isn't worth it now. My daughter had LASIK two years ago.

Stephen W. Stanton writes:

You should get PRK.
Basically the same as LASIK... Slightly longer healing time, less chance of halos and longer-term problems.
http://www.prk.com/medical.html#PRK%20Comparison

Go to a top doctor. It makes a difference.

The procedure is measured in seconds (dozens of seconds)... So don't work yourself up over it.

Aaron Todd writes:

Do it! You said yourself that getting LASIK would only require a "a small investment". The benefit of the procedure obviously outweighs your risks. Maximize that utility and go for it! Although glasses do portray a much more scholarly economist, I think that opportunity cost in particular is low.

HispanicPundit writes:

I had it and absolutely love it.

Don't pay too much attention to the stats on complications as LASIK has greatly advanced over the years and I bet the data is skewed with the numbers from surgeries done with much older equipment. Find yourself a respected doctor, preferrably the best in the area and one that uses the latest equipment, and you will be fine. I've had it, my friends and family have had it and we all loved it and to this day, many years later, have not had any complications.

This is the eye doctor that did my surgery,

http://www.castervision.com/

He has also done it for basketball players and golfers and other professional atheletes - people who have alot more riding on their eye sight. They all came out okay as well.

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